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MrMango's Latest Activity

  1. MrMango

    Can you return to dialysis after 11 years away?

    I've done both inpatient and outpatient dialysis. I left within the year but am considering going back... however I'm the opposite. I would never go back to inpatient HD. I loved the job very much and it was very exciting, however I could no longer do the on-call portion.
  2. Greetings all! I'm a registered nurse from New England who is looking for a change of pace. My background: I've been a RN since 2014, I've worked in Chronic & Acute Hemodialysis in both an outpatient clinic and a hospital setting for four years, and have spent the last year as a Nurse Coordinator in Pain Management. My job now is.... ok. It's not as much patient interaction as I had hoped and I dislike the lack of clinical skills in my position. I've been looking into a new specialty in nursing. I've always had an interest in home hospice nursing, as I feel like I can connect with patients & families very well and it's a good use of my compassion. I have much experience with death in patients, as anyone who works/worked in hemodialysis, its frequent among that patient population. A few questions: 1. What are the hours like typically? M-F? Autonomy? 2. Home-Work balance. Are the two able to separate? Will patients/families be calling me on off-hours? Will I work on my days off? Will I be charting at home after my shift? 3. Any companies/organizations to avoid? 4. How to begin looking for hospice RN jobs? 5. Questions to ask during the interview? Any and all information is helpful! Thank you so much, look forward to the discussion!
  3. MrMango

    Labs after dialysis

    One nephrologist I work with and have the utmost respect and trust has told me the same thing. A minimum of four hours should be given post-dialysis for drawing labs that can be considered accurate. I try to pass this along to every primary RN I come in contact with. (also I work in Acute Inpatient HD)
  4. Hey all, a little background about myself: I have worked in dialysis for two years, first at FMC outpatient, then I moved to a not-for-profit independent outpatient unit at the largest hospital in my state (Connecticut), and in October 2017 I transitioned to the Acute Inpatient Dialysis in my hospital. I love the differences from inpatient to outpatient. I often do beside treatments in the ED, SD, or ICU units and I have been exposed to so much and learned an unbelievable amount in my short time as an Acute HD RN. The knowledge has been priceless and I truly believe it has propelled me into becoming a better nurse. HOWEVER, I don't know how the Acutes work for hospitals contracted to Davita or FMC, but for my unit, we run 1-on-1 bedside treatments for Step-Down and ICU level of care, but Floor level care we bring them to our unit, where we have 8 stations. On a typical day, we are staffed two staff RNs and one charge RN. One of the two staff RNs goes to do bedside treatments, while the expectation is the other staff RN runs 4 patients at a time with a CCHT, while the charge RN runs two patients and when a second CCHT arrives at 10am (we clock in at 6am), the charge RN is expected to add a third patient to their assignment and run three patients with a CCHT while still maintaining charge. I have not done in depth research on ratios, but I have done some, and from what I've seen, while four patients to an RN and a CCHT is not unheard of, it is not frequently practiced. My personal opinion is the ratio I currently operate under is unsafe. While the CCHTs I work with are very skilled and very good at their position, four patients means four assessments, four med passes, four reports, four everything. Often my CCHT only puts on two or three of the four patients because my manager expects any patient that enters the room to be put on dialysis immediately, so often I am putting on a patient while the CCHT puts on another, and then I have to go back and assess the patient the CCHT put on AFTER they've already been on dialysis for 10-15 minutes. I have brought this up to my manager multiple times, but since there is no law in Connecticut concerning this, it often falls on deaf ears. I have been told by my coworkers that previous RNs who have left the position had the same concerns/complaints about what they considered an unfair ratio, and they were retaliated against. My manager seems to like me, however I am afraid if I continue to push this issue, I fear retaliation. I am skeptical and untrusting of Human Resources as well, as I believe their best interest will always be to protect the hospital and not an individual employee. So if I can pick some brains on this, I'd appreciate it: What is your nurse-to-patient ratio on your acute HD unit? If so, what state do you practice in? What can I do about my predicament? Has anyone been in this situation where you felt your patient ratio was unsafe? What did you do? How was it handled? Any insight would be appreciated. I am very passionate about Nursing and the unit I work on. I've gotten to know our frequent readmits quite well, and I often see and dialyze patients I know from the different local outpatient units I work on. Leaving the position is my ultimate LAST resort, and I do not want it to come to that. However, I worked very hard and went through hell and back to achieve my nursing license, and I plan to protect it with my life and while not risk it unsafely practicing under and organization's protocol. Thank you for any insight you can offer>
  5. MrMango


    Dialysis is complicated, but in my experience pays well. I've been in dialysis for almost two years, the past 7 months at a major area hospital, in the acute dialysis setting. I make an awesome hourly rate with virtually all the overtime I want. I consistently am able to work between 50-60 hours a week, if I choose. Now it's just a question of how long I can go like this. The money is nice, but I can already see the potential of burnout on the horizon. I liked the consistency of a 40hr work week in outpatient chronic, so that's always a nice fall back. Bottom line: There is money, hours, and demand for dialysis nurses.
  6. MrMango

    How to get into Travel Nursing?

    Hello all, I'm a relatively new nurse, I've worked in Outpatient Dialysis for a year. Recently, I've been putting some thought into travel nursing. However I don't know how to go about looking into getting hired through an agency, which agencies to go with or avoid, and how to get the process going, or if I even have enough experience yet. I'd like to stick in my specialty of Dialysis. Any input is appreciated!
  7. MrMango

    Old Dialysis Nurse- wanting to go back

    Must be dependent on your location... I'm from Connecticut and recently left my full-time position at Fresenius (I still work per diem) in favor of a hospital, but I still get e-mails about Fresenius openings in my state and there's always at least two RN postings at any given time. The clinic I just left hired 4 nurses in the past year, three of them new grads,
  8. MrMango

    Dialysis Dilemma?

    I recently left a Freestanding clinic (in favor of a Dialysis RN position at a large hospital), and I've never experienced a loss of hours because a patient didn't show up. The way my old clinic was scheduled, it was three "shifts" of patients, myself and a tech being responsible for six at a time. If one or two didn't show up on my last shift of patients, I just had a lower ratio.... if that ratio ever dropped to three patients or less, my tech would be sent home first. Overall, most weeks I was actually working OT, never had a problem not hitting my 40 hours, if I did, I still hit 80 in a pay period (ie 35 one week, 45 the following). Just be careful about the freestanding company you're working for... I've heard horror stories about some companies.
  9. MrMango

    Never Give Up -- My Story

    After some of the harsh criticisms and negativity when I created this thread, I left allnurses.com to focus on obtaining job to begin my career. I returned today out of boredom, curiosity, and to connect with other nurses in my specialty, and stumbled back on this thread, the last time I posted on this website. First, let me say, thank you to all for the kind words! I truly appreciate the sentiments and I apologize it has taken me over a year to respond. To those of you looking for inspiration, I hope my story truly did help you and I would be honored to help anyone struggling. Second, I'm glad this thread could incite such a great debate among fellow nurses, regardless of what you believe on the matter. A little update on my end: It was difficult to find a job initially, almost every place I applied in the State of Connecticut required a certain amount of experience, which I had none. I faced a typical new grad problem, but fortunately found a job in Dialysis, and I absolutely love it! I've been a Dialysis RN for just over a year and am now aiming to transfer over to the largest Hospital in my State, and to remain in Dialysis, then begin school next fall for my MSN, aiming to become an FNP, specializing in nephrology. And despite having to take my NCLEX so many times, I've turned out to be a pretty darn great nurse. I've received two Nurse of the month, and one Nurse of the Quarter recognition from my clinic, a trait my charge nurse and my clinical manager credit to my compassion, my drive for my patient care, and competency in care. I'm excited for the future. So anyone struggling, don't listen to these cranky old bats that feed off negativity on this website. Yes, competency does make a good nurse and is a requirement for all nurses, but GREAT nurses have a drive and a fire inside, an ability to connect with their patients, empathy and compassion. Don't EVER let someone take that skill from you. If nursing is just your job, then yes, be fine with being as competent as possible, because nursing is about competency. But in this nurse's opinion, competency is just achieving the minimum requirements.
  10. MrMango

    Never Give Up -- My Story

    Perhaps it is a combination of both? I'm not sure how you can sit there and tell me that passion, desire, and the person you are are not components of a good nurse. I know plenty of nurses that passed on the first try, yet have no interpersonal skills and are there for the paycheck, not for the better of the community. I hope you're not one of them. I appreciate your insight, but this story was to help others, not kick them while they're down. I don't want to make assumptions, but I hope you're not one of those nurses that wouldn't help a fellow struggling RN. Please refrain from negativity in this thread, thanks. :) EDIT: Also Ruby, critical thinking and competency are skills you can LEARN and ACQUIRE over time. My nursing program was not very good at teaching critical thinking, it was something I learned on my own. Passion and desire cannot be taught, that comes from within.
  11. MrMango

    Never Give Up -- My Story

    Thanks for the kind words everyone!
  12. MrMango

    Never Give Up -- My Story

    Hello to all my fellow nurses and future nurses! I finally passed my NCLEX-RN and I wanted to share my journey with you all in hopes that it can help at least one struggling person! I graduated and obtained my BSN in May 2013 and due to a clerical error with my transcript, I was unable to even register for my NCLEX until September 2013 and did not sit for my initial try until October 2013. In that time I did not study or take the NCLEX seriously at all. Despite being in the top percentile for clinical rotation grades and high praise from clinical instructors, I struggled in the classroom my senior year of nursing school, which reflected poorly when it came to the NCLEX. I failed, then I failed again.... and again.... and again. I took Kaplan, ATI, Hurst, Learningext, but I kept failing. I remember reading a statistic that repeat test-takers are twice as likely to fail again... and for me it was true. I lost all confidence in myself, questioned my life, questioned my desire. I was embarrassed to see family members and friends from nursing school. Eventually my own parents (who have always been as supportive as possible) subtly suggested I pursue a different career path. And I was about to.... after my most recent failure I came across a thread on these message boards about a student who had failed as many times as myself seeking help. One of the first replies from a member here suggested the person give up because if they could not accomplish passing the NCLEX, they had no business becoming a nurse. Now, while other nurses quickly jumped the defense of this poor student, the initial reply hit close to home for me. I won't lie, I broke down into tears. The next day I started looking into going back to school or getting a full time job anywhere. But I didn't. I had a fire inside of me that would not be extinguished. I wouldn't abandon my dream of being an RN or all the hard-work up until that point without giving it one hell of a last chance. Every day for two months after getting out of work at 5pm, I'd go to my local library and study. Anything I was not proficient in (for me was pharmacology and maternity) I would study extensively and make study guides for. I'd cap off the night with anywhere from 50 to 100 question tests on Uworld.com, which is by far my favorite of all NCLEX-RN preparation websites. At the beginning of October, full of confidence and knowledge, I walked into my local Pearson Vue testing center and did what I was meant to do, become a registered nurse. I've had a lot of introspection the past two years and the past three months about who I am as a man, and who I want to be, and although it took me a long time, I shall forever be eternally grateful for the learning experience this was. When I graduated I thought I was invincible, and I'm grateful for the humility I've gained. My message to you, someone who has failed once, twice, or ten times, is STOP, BREATHE, AND THINK. You can do this and you WILL do this. It is worth any sacrifice you have to make, just please DON'T EVER GIVE UP and DON'T EVER THINK YOU ARE WORTHLESS OR ALONE. Because you aren't. There are a ton of us who have been repeat testers and it does not reflect whether you'll be good nurse or not. How you act, how you carry yourself, your passion, your desire, that is what will make you a great nurse. Although I'm a new RN, we as nurses are a family, we love you, I love you, keep fighting the fight. My message to someone who is still in school or has yet to attempt the NCLEX-RN is please, take is seriously. Don't make the same mistake I did. I was so glad to just be done with nursing school, I lost sight of what was really important and had my priorities mixed up. The small sacrifice of not going out on the weekends or having to spend a few hours at the library each night is worth it. Best of luck to you all and I hope this helps at least one person!
  13. MrMango

    New RN -- need advice!

    Hey all! I just passed my NCLEX-RN last week, glad to have that part of my life in the past, but am now facing my next nerve-wracking step in life (albeit much more exciting). I haven't applied for any kind of new job in about seven years, so I'm fairly new to the whole career-search thing. A little backstory, I graduated nursing school in the Spring of 2013, and after failing my NCLEX-RN twice, I took a full-time position in the company I already worked for. Realizing that was not how I wanted my life to go, I decided to return to my original passion of nursing, buckled down and passed my NCLEX! I've been looking at different job posting websites and different hospitals in my area, and I've noticed that many positions require something between a year to two years experience. This scares me! I'm not picky and ideally would work in any field to get myself going, my only stipulation being that I want a fulltime position. I also have no clue what to include on my resume.... Looking for any insight that I can use to help write it or what to include, and also ideas for where I can apply. And shot in the dark.... I'm licensed in Connecticut if anyone from there sees this and can offer me advice. Thank you very much!
  14. MrMango

    NCLEX Question Type! PLEASE HELP

    Anything more specific? Prioritization for me also means "which should the nurse do FIRST", those types....
  15. MrMango

    NCLEX Question Type! PLEASE HELP

    I recently failed my NCLEX-RN. I failed in 265 questions (which means I was close, right?) However one type of question I saw frequently during my NCLEX were questions that gave me four patients, their symptoms and then asked me which patient I would see FIRST. Some of them seemed pretty obvious, but others (read: most) were difficult to decide which patient was the priority. Is there a specific name for these types of questions? Is there a way to study these types of questions? I have "Prioritization, Delegation, and Assignment (3rd Edition)" from Elsevier, and while it is an excellent book, it doesn't have the type of Prioritization questions I am referring to above. Thanks for the read and your help! :)